Posttraumatic Stress Disorder

Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) can be a very serious and debilitating condition that occurs after a person has been exposed to a terrifying event or ordeal in which grave physical danger happened or was threatened. The kinds of traumatic events triggering PTSD in people include violent personal assaults (rape, mugging), natural disasters (hurricanes, tornadoes), man-made disasters (bombings), accidents or military combat. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair a person's daily life. PTSD is a complicated illness by the act that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health.

PTSD is not a new disorder. There are many written accounts of similar symptoms that go back to ancient times. There is also clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Ad Costa's Syndrome." There are also good descriptions of PTSD in medical literature based on combat veterans of World War II and on Holocaust survivors. In 1980, the American Psychiatric Association added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III) nosologic classification scheme. The key to understanding PTSD is the concept of trauma. A traumatic event was seen as a catastrophic stressor that was outside the range of usual human experience. The original diagnosis was made due to events such as war, torture, rape, the Nazi Holocaust, the atomic bombings of Hiroshima and Nagasaki, natural disasters, and human-made disasters. They considered traumatic events to be clearly different from the painful stressors of every day events such as divorce, failure, rejection, serious illness, and financial reverses. Because all people handle stress on different levels it is very had to determine who will suffer from PTSD when exposed to traumatic events.

Diagnostic criteria for PTSD include a history of exposure to a traumatic event and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of the symptoms. Recent data from the national comorbidity survey indicates PTSD prevalence rates are 5% and 10% respectively among American men and women (Kessler et al., 1996). Rates of PTSD are much higher in post-conflict settings such as Algeria (37%), Cambodia (28%), Ethiopia (16%), and Gaza (18%)(de Jong et al., 2001).

The first stressor criterion specifies that a person has been exposed to a catastrophic event involving actual or threatened death or injury. The second criterion, or intrusive recollection, includes symptoms that are distinctive and easily identified of PTSD. These emotions manifest in daytime fantasies, traumatic nightmares, and psychotic reenactments know as flashbacks. The third criteria, avoidant/numbing, consists of symptoms that reflect behavioral, cognitive, or emotional strategies the PTSD patients use in an attempt to reduce the likelihood that they will expose themselves to trauma-related stimuli. The fourth criteria, hyper-arousal, most closely resembles those seen in panic and generalized anxiety disorders. While symptoms such as insomnia and irritability are generic anxiety symptoms, hyper-vigilance and startle are more characteristic of PTSD. The fifth criteria, duration, specifies how long symptoms must persist in order to qualify for a PTSD diagnosis. The last criteria, functional significance, specify that the survivor must experience significant social, occupational, or other distress as a result of these symptoms. Since 1980, there has been a great deal of attention devoted to the development of instruments for assessing PTSD. Keane and associates (1987) working, with Vietnam war-zone veterans, have developed both psychometric and psycho physiologic assessment techniques that have proven to be valid and reliable. Other investigators have modified such assessment instruments and used them with natural disaster victims, rape/incest survivors, and other traumatized individuals. Research has shown that PTSD can become a chronic psychiatric disorder and can persist for decades and sometimes for a lifetime. People with chronic PTSD often exhibit a course marked by remissions and relapses.

The many therapeutic approaches offered to PTSD patients are presented in Foa, Keane, and Freidman's (2000) comprehensive book on treatment. The most successful interventions are cognitive-behavioral therapy (CBT) and medication. Excellent results have been obtained with some CBT combinations of exposure therapy and cognitive restructuring, especially with female victims of childhood or adult sexual trauma. Sertraline (Zoloft) and paroxetine (Paxil) are selective serotonin reuptake inhibitors (SSRI) that are the first medications to have received FDA approval as indicated treatments for PTSD. Perhaps the best therapeutic option for mildly to moderately affected PTSD patients is group therapy. In such a setting, the PTSD patient can discuss traumatic memories, PTSD